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Search Results: 1 - 10 of 915 matches for " Raffaele Scala "
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Noninvasive mechanical ventilation for very old patients with limitations of care: is the ICU the most appropriate setting?
Raffaele Scala, Antonio Esquinas
Critical Care , 2012, DOI: 10.1186/cc11352
Abstract: Bearing this scenario in mind, we wonder whether the intensive care unit (ICU) is the best setting for NIV in 'older elderly DNI patients' [2,3]. While the use of NIV in patients with acute respiratory failure without preset limitations on life-sustaining treatment may be implemented in different settings (ICUs, respiratory ICUs (RICUs), and emergency rooms), depending on the typology of acute syndrome and the likelihood of success, the ideal care for 'DNI patients' is likely to be more appropriate outside the ICU [2]. In fact, for these patients for whom endotracheal intubation is questionable or care is centered largely on symptom palliation or both, NIV failure requires the intensification of comfort measures only, adequately performed in totally or partially 'open' environments [2,3]. The option of NIV in end-of-life decisions is emerging in European RICUs, where a large majority of DNI patients are treated by pulmonologists [3]. This is not surprising, as RICUs differ substantially from ICUs in terms of patient population, staffing, monitoring, and use of NIV as the preferred ventilatory approach [4]. Furthermore, a recent American survey showed that the stated use of NIV and the confidence in its utility in end-of-life patients were greater for pulmonologists than for intensivists [5]. A pulmonologist's point of view may be influenced by caring for end-stage respiratory patients over the entire spectrum of their illness as opposed to the greater focus on acute care among intensivists.In conclusion, the assignment of 'older elderly DNI patients' to an environment, such as the ICU, that was originally designed to treat patients without preset limitations of care (that is, invasive mechanical ventilation) raises financial and ethical concerns, namely (a) the questionable cost-utility ratio of allocating the precious limited ICU resources for patients whose needs may be met by lower levels of care (that is, nurse workload) and (b) the inappropriateness of a 'close
La ventilación no invasiva con presión positiva en la insuficiencia respiratoria aguda hipercápnica: diez a?os de experiencia clínica de una unidad de terapia semiintensiva respiratoria
Scala,Raffaele; Naldi,Mario;
Revista Ciencias de la Salud , 2007,
Abstract: background although several prospective controlled randomized trials demonstrated the success of non-invasive positive pressure ventilation (nippv) in selected cases of acute hypercapnic respiratory failure (arf) in setting with different care levels, clinical practice data about the use of vni in the ?real world? are limited. aim to report the results of our clinical experience in nippv applied for arf in the respiratory semi-intensive care unit (utsir) allocated within the respiratory division of arezzo between the years 1996- 2006 in terms of: patient tolerance, effects upon arterial blood gases, success rate and predictors of failure. methods: three hundred and filthy out of the 1484 patients (23.6%) consecutively admitted for arf to our respiratory division during the study period received nippv in addition to standard therapy, according to the predetermined routinely used criteria. results: eight patients (2.3%) did not tolerate nippv because of mask discomfort, while the remaining 342 (m: 240, f: 102); median (interquartiles) age: 74.0 (68.0-79.3) yrs; copd: 69.3%) were ventilated for >1 hour. arterial blood gases significantly improved after two hours of nippv (mean (standard deviation) ph: 7.33 (0.07) versus 7.28 (7.25-7.31), p<0.0001; paco2: 71.4 (15.3) mmhg versus 80.8 (16.6) mmhg, p<0.0001; pao2/fio2: 205 (61) versus 183 (150-222), p<0.0001). nippv avoided intubation in 285/342 (83.3%) with a hospital mortality of 14.0%. nippv failure was independently predicted by the apache iii (acute physiology and chronic health evaluation iii) score, the body mass index and by the late failure of nippv (> 48 hrs of ventilation) after an initial positive response. conclusions: as results of ten years of clinical experience at our utsir, nippv was shown to be well tolerated, effective in improving arterial blood gases and useful in avoiding intubation in most arf episodes non-responsive to standard therapy.
Non-invasive positive pressure ventilation in acute hypercapnic respiratory failure: ten-year’s clinical experience of a Respiratory Semi-Intensive Care Unit (VERSIONE IN ITALIANO)
Raffaele Scala,Mario Naldi
Revista Ciencias de la Salud , 2007,
Abstract: BackgroundAlthough several prospective controlled randomizedtrials demonstrated the success of non-invasive positive pressure ventilation (NIV) in selected cases of acute hypercapnic respiratory failure (IRA) in setting with different care levels, clinical practice data about the use of NIV in the “real world” are limited.AimTo report the results of our clinical experience in NIV applied for IRA in the Respiratory Semi-Intensive Care Unit (UTSIR) allocated within the Respiratory Division of Arezzo in the years 1996-2006 in terms of: tolerance, effects upon arterial blood gases, success rate and predictors of failure.MethodsThree hundred filthy of the 1484 patients (23.6%) consecutively admitted for IRA to our RespiratoryDivision during the study period received NIV in addition to standard therapy, according to the pre-defined routinely used criteria.ResultsEight patients (2.3%) did not tolerated NIV becauseof mask discomfort, while the remaining 342 (M: 240, F: 102; median (interquartiles) age: 74.0 (68.0-79.3) yrs; COPD: 69.3%) were ventilatedfor >1 hour. Arterial blood gases significantlyimproved after two hours of NIV (mean (standard deviation) pH: 7.33 (0.07) versus 7.28 (7.25-7.31), p<0.0001; PaCO2: 71.4 (15.3) mmHg versus 80.8 (16.6) mmHg, p<0.0001; PaO2/FiO2: 205 (61) versus 183 (150-222), p<0.0001). NIV avoided intubation in 285/342 (83.3%) with an hospital mortality of 14.0%. NIV failure was independently predicted by the Apache III (Acute Physiology and Chronic Health Evaluation III) score, the body mass index and by the late failure of NIV (> 48 hrs of ventilation) after an initial positive response.ConclusionsAs results of our ten-year’s clinical experience performed in a UTSIR, NIV is confirmed to be well tolerated, effective in improving arterial blood gases and useful in avoiding intubation in most IRA episodes non-responder to standard therapy.
Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia
Raffaele Scala, Mario Naldi, Uberto Maccari
Critical Care , 2010, DOI: 10.1186/cc8993
Abstract: This is a 12-month prospective matched case-control study performed in one respiratory semi-intensive care unit (RSICU) with expertise in NPPV and in one intensive care unit (ICU). Fifteen acutely decompensated COPD patients with copious secretion retention and HE due to CAP undergoing NPPV in RSICU, and 15 controls (matched for arterial blood gases, acute physiology and chronic health evaluation score III, Kelly-Matthay scale, pneumonia extension and severity) receiving CMV in the ICU were studied.Two hours of NPPV significantly improved arterial blood gases, Kelly and cough efficiency scores without FBO-related complications. NPPV avoided intubation in 12/15 patients (80%). Improvement in arterial blood gases was similar in the two groups, except for a greater PaO2/fraction of inspired oxygen ratio with CMV. The rates of overall and septic complications, and of tracheostomy were lower in the NPPV group (20%, 20%, and 0%) versus the CMV group (80%, 60%, and 40%; P < 0.05). Hospital mortality, duration of hospitalisation and duration of ventilation were similar in the two groups.In patients with decompensated COPD due to CAP who are candidates for CMV because of HE and inability to clear copious secretions, NPPV with early therapeutic FBO performed by an experienced team is a feasible, safe and effective alternative strategy.Non-invasive positive pressure ventilation (NPPV) is the first-line treatment of hypercapnic acute respiratory failure (ARF) in severe chronic obstructive pulmonary disease (COPD) exacerbations. Compared with standard medical therapy, it reduces the rate of endotracheal intubation (ETI) and the associated complications, as well as the mortality and length of stay in hospital [1,2]. However, the inefficacy to spontaneously clear airways from an excessive burden of respiratory secretions is likely to cause NPPV failure [3,4]. This is due to the kinds of interfaces used to deliver NPPV, which do not allow direct access into the airways. Conversely,
Non-Invasive Positive Pressure Ventilation in Acute Hypercapnic Respiratory Failure: Ten-Year’s Clinical Experience of a Respiratory Semi-Intensive Care Unit
Raffaele Scala, M.D., esp.,Mario Naldi, M.D., esp.
Revista Ciencias de la Salud , 2007,
Abstract: BackgroundAlthough several prospective controlled randomizedtrials demonstrated the success of non-invasive positive pressure ventilation (NIPPV) in selected cases of acute hypercapnic respiratory failure (ARF) in setting with different care levels, clinical practice data about the use of VNI in the “real world” are limited.AimTo report the results of our clinical experiencein NIPPV applied for ARF in the Respiratory Semi-Intensive Care Unit (UTSIR) allocated within the Respiratory Division of Arezzo betweenthe years 1996-2006 in terms of: patient tolerance, effects upon arterial blood gases, successrate and predictors of failure. Methods: Three hundred and filthy out of the 1484 patients (23.6%) consecutively admittedfor ARF to our Respiratory Division during the study period received NIPPV in addition to standard therapy, according to the predeterminedroutinely used criteria. Results: Eight patients (2.3%) did not tolerateNIPPV because of mask discomfort, while the remaining 342 (M: 240, F: 102); median (interquartiles)age: 74.0 (68.0-79.3) yrs; COPD: 69.3%) were ventilated for >1 hour. Arterial blood gases significantly improved after two hours of NIPPV (mean (standard deviation) pH: 7.33 (0.07) versus 7.28 (7.25-7.31), p<0.0001; PaCO2: 71.4 (15.3) mmHg versus 80.8 (16.6) mmHg, p<0.0001; PaO2/FiO2: 205 (61) versus 183 (150-222), p<0.0001). NIPPV avoided intubationin 285/342 (83.3%) with a hospital mortality of 14.0%. NIPPV failure was independentlypredicted by the Apache III (Acute Physiology and Chronic Health Evaluation III) score, the body mass index and by the late failure of NIPPV (> 48 hrs of ventilation) after an initial positive response. Conclusions: As results of ten years of clinicalexperience at our UTSIR, NIPPV was shown to be well tolerated, effective in improving arterialblood gases and useful in avoiding intubationin most ARF episodes non-responsive to standard therapy.
Optimization of ventilator setting by flow and pressure waveforms analysis during noninvasive ventilation for acute exacerbations of COPD: a multicentric randomized controlled trial
Fabiano Di Marco, Stefano Centanni, Andrea Bellone, Grazia Messinesi, Alberto Pesci, Raffaele Scala, Andreas Perren, Stefano Nava
Critical Care , 2011, DOI: 10.1186/cc10567
Abstract: The aim of the present randomized, multi-centric, controlled study was to compare optimized ventilation, driven by the analysis of flow and pressure waveforms, to standard ventilation (same physician, same initial ventilator setting, same time spent at the bedside while the ventilator screen was obscured with numerical data always available). The primary aim was the rate of pH normalization at two hours, while secondary aims were changes in PaCO2, respiratory rate and the patient's tolerance to ventilation (all parameters evaluated at baseline, 30, 120, 360 minutes and 24 hours after the beginning of ventilation). Seventy patients (35 for each group) with acute exacerbation of COPD were enrolled.Optimized ventilation led to a more rapid normalization of pH at two hours (51 vs. 26% of patients), to a significant improvement of the patient's tolerance to ventilation at two hours, and to a higher decrease of PaCO2 at two and six hours. Optimized ventilation induced physicians to use higher levels of external positive end-expiratory pressure, more sensitive inspiratory triggers and a faster speed of pressurization.The analysis of the waveforms generated by ventilators has a significant positive effect on physiological and patient-centered outcomes during acute exacerbation of COPD. The acquisition of specific skills in this field should be encouraged.ClinicalTrials.gov NCT01291303.Noninvasive positive pressure ventilation (NIV) is to date the first-line intervention for patients suffering from acute exacerbation of chronic obstructive pulmonary disease (COPD) and respiratory acidosis, reducing intubation rate and mortality [1-3]. The failure rate of NIV (that is, the need for endotracheal intubation or death) for this collective is up to 25% [1,4-6], a percentage varying significantly according to the timing of NIV application and the fast response to this treatment [5]. During the most commonly used mode of NIV-Pressure Support Ventilation (PSV)-the "independent" varia
On the New Boson Higgs’s Studies at the CERN-ATLAS Experiment. The Emergency of a Historical Discovery  [PDF]
Raffaele Pisano
Advances in Historical Studies (AHS) , 2013, DOI: 10.4236/ahs.2013.21002
Abstract: This paper is a summary of the interview-workshop to Aleandro Nisati (12 December 2012, SEMM-Service Enseignement et Multimédia) co-organized by UFR Physique, University of Lille 1, France (Raffaele Pisano, Remi Franckowiak, Bernard Maitte and Lisa Rougetet), ATLAS Experiment Team (CERN, Genève, Switzerland), in persons of the cited Italian scientist—already Physics coordinator at ATLAS—and his colleague, Steven Goldfarb (CERN-University of Michigan, USA). The latter kindly answered to the questions on the ATLAS detector, LHC machine and CERN-ATLAS laboratories proposed by the participants. Distinguished lectures by historians of science at University of Lille 1 (Bernard Maitte, Bernard Pourprix and Robert Locqueneux) specialist on history of physics opened the workshop session.
Review Ph.D. Thesis: Psyco-Education Factors of Applying Visualisation in Science Education. Siauliai University, Lithuania  [PDF]
Raffaele Pisano
Advances in Historical Studies (AHS) , 2013, DOI: 10.4236/ahs.2013.21005
Abstract: This paper presents a review of a Ph.D. Thesis by Renata Bilbokaite, Natural Science Education Research Centre, Siauliai University, Lithuania.
Reflections on the Scientific Conceptual Streams in Leonardo da Vinci and His Relationship with Luca Pacioli  [PDF]
Raffaele Pisano
Advances in Historical Studies (AHS) , 2013, DOI: 10.4236/ahs.2013.22007
Abstract: Leonardo da Vinci (1452-1519) is perhaps overrated for his contributions to physical science, since his technical approach. Nevertheless important components concerning practical problems of mechanics with great technical ability were abounded. He brought alive again the Nemorarius’ (fl. 12th - 13th century) tradition and his speculations on mechanics, if immature made known how difficult and elusive were the conceptual streams of the foundations of science for practitioners-artisans. Leonardo also had an interesting and intense relationship with mathematics but merely unhappy insights in his time. The meeting with Luca Bartolomeo de Pacioli (1445-1517) was very important for da Vinci since proposing stimulating speculations were implemented, but they were not definitive theoretical results. In this paper historical reflections notes on mechanics and mathematics in da Vinci and his relationships with Pacioli are presented.
Introduction to Advances Historical Studies—Newton Special Issue. History and Historical Epistemology of Science  [PDF]
Raffaele Pisano
Advances in Historical Studies (AHS) , 2014, DOI: 10.4236/ahs.2014.31001
Abstract: Introduction to Advances Historical Studies
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